瑞士普通成年人群中血清25-羟维生素D水平与肾功能下降情况
Serum 25-hydroxyvitamin D level and kidney function decline in a Swiss general adult population.
作者信息
Guessous Idris, McClellan William, Kleinbaum David, Vaccarino Viola, Hugues Henry, Boulat Olivier, Marques-Vidal Pedro, Paccaud Fred, Theler Jean-Marc, Gaspoz Jean-Michel, Burnier Michel, Waeber Gérard, Vollenweider Peter, Bochud Murielle
机构信息
Division of Chronic Diseases, Institute of Social and Preventive Medicine, Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
出版信息
Clin J Am Soc Nephrol. 2015 Jul 7;10(7):1162-9. doi: 10.2215/CJN.04960514. Epub 2015 Apr 21.
BACKGROUND AND OBJECTIVES
Molecular evidence suggests that levels of vitamin D are associated with kidney function loss. Still, population-based studies are limited and few have considered the potential confounding effect of baseline kidney function. This study evaluated the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline, and incidence of CKD and albuminuria.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Baseline (2003-2006) and 5.5-year follow-up data from a Swiss adult general population were used to evaluate the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline (annual loss >3 ml/min per 1.73 m(2)), and incidence of CKD and albuminuria. Serum 25-hydroxyvitamin D was measured at baseline using liquid chromatography-tandem mass spectrometry. eGFR and albuminuria were collected at baseline and follow-up. Multivariate linear and logistic regression models were used considering potential confounding factors.
RESULTS
Among the 4280 people included in the analysis, the mean±SD annual eGFR change was -0.57±1.78 ml/min per 1.73 m(2), and 287 (6.7%) participants presented rapid eGFR decline. Before adjustment for baseline eGFR, baseline 25-hydroxyvitamin D level was associated with both mean annual eGFR change and risk of rapid eGFR decline, independently of baseline albuminuria. Once adjusted for baseline eGFR, associations were no longer significant. For every 10 ng/ml higher baseline 25-hydroxyvitamin D, the adjusted mean annual eGFR change was -0.005 ml/min per 1.73 m(2) (95% confidence interval, -0.063 to 0.053; P=0.87) and the risk of rapid eGFR decline was null (odds ratio, 0.93; 95% confidence interval, 0.79 to 1.08; P=0.33). Baseline 25-hydroxyvitamin D level was not associated with incidence of CKD or albuminuria.
CONCLUSIONS
The association of 25-hydroxyvitamin D with eGFR decline is confounded by baseline eGFR. Sufficient 25-hydroxyvitamin D levels do not seem to protect from eGFR decline independently from baseline eGFR.
背景与目的
分子证据表明维生素D水平与肾功能丧失有关。然而，基于人群的研究有限，很少有研究考虑到基线肾功能的潜在混杂效应。本研究评估了血清25-羟基维生素D与估算肾小球滤过率（eGFR）变化、eGFR快速下降以及慢性肾脏病（CKD）和蛋白尿发病率之间的关联。
设计、地点、参与者及测量方法：使用来自瑞士成年普通人群的基线（2003 - 2006年）和5.5年随访数据，评估血清25-羟基维生素D与eGFR变化、eGFR快速下降（每年下降>3 ml/min per 1.73 m²）以及CKD和蛋白尿发病率之间的关联。基线时采用液相色谱 - 串联质谱法测量血清25-羟基维生素D。在基线和随访时收集eGFR和蛋白尿数据。使用多变量线性和逻辑回归模型，并考虑潜在的混杂因素。
结果
在纳入分析的4280人中，平均±标准差的年eGFR变化为-0.57±1.78 ml/min per 1.73 m²，287名（6.7%）参与者出现eGFR快速下降。在调整基线eGFR之前，基线25-羟基维生素D水平与年平均eGFR变化以及eGFR快速下降风险均相关，且独立于基线蛋白尿。一旦调整基线eGFR，这种关联不再显著。基线25-羟基维生素D每升高10 ng/ml，调整后的年平均eGFR变化为-0.005 ml/min per 1.73 m²（95%置信区间，-0.063至0.053；P = 0.87），eGFR快速下降风险为零（比值比，0.93；95%置信区间，0.79至1.08；P = 0.33）。基线25-羟基维生素D水平与CKD或蛋白尿的发病率无关。
结论
25-羟基维生素D与eGFR下降之间的关联受基线eGFR的混杂影响。充足的25-羟基维生素D水平似乎并不能独立于基线eGFR预防eGFR下降。
Zotero 插件